- What Certification in Congenital Cardiac Surgery Actually Tests
- Exam Format: Written Part I and Oral Part II
- The 11 Content Domains You Must Master
- Fees, Registration, and 2026 Dates
- Eligibility Checkpoints Before You Register
- A Domain-Driven Study Timeline
- Preparing for the Dallas Oral Examination
- Pitfalls That Sink First-Attempt Candidates
- Frequently Asked Questions
- Written questions have used only three answer options since 2025 - eliminate two, not four, distractors.
- Total initial fees run $4,900: $650 application, $1,750 written, $2,500 oral, before travel.
- The 2026 written window is December 7-11; the oral exam follows in Dallas on June 4-5, 2027.
- You must pass the Part I written exam before ABTS will schedule your Part II oral.
What Certification in Congenital Cardiac Surgery Actually Tests
Certification in Congenital Cardiac Surgery (CHS) is the American Board of Thoracic Surgery's subspecialty credential for surgeons who have completed dedicated congenital training beyond general thoracic and cardiac surgery. It is distinct from primary ABTS certification and from the separate continuing-certification assessment that maintaining diplomates complete later. This guide focuses on the initial pathway: preparing for the Part I written exam, with a supporting look at Part II oral case preparation.
If you're still getting oriented to the credential itself, our companion pieces on What Is CHS? and CHS Certification walk through the basics before you dive into study planning here.
Exam Format: Written Part I and Oral Part II
Part I is a multiple-choice written examination delivered at Pearson Professional Testing Centers. A structural change candidates should internalize: starting in 2025, written questions present three answer options rather than the traditional four or five. This tightens the margin for careless elimination - with fewer distractors, examiners can write options that are each individually plausible, so partial knowledge is less forgiving than it might seem.
You must pass the written exam before ABTS will permit you to sit for the in-person Part II oral examination, which uses case-based discussion format. For a deeper look at how ABTS defines a passing threshold on the written exam, see CHS Passing Score 2026: Exactly What You Need to Pass, and for a broader difficulty comparison across both exam stages, read How Hard Is the CHS Exam? Complete Difficulty Guide 2026.
Key Takeaway
Practice with three-option question banks specifically - drilling on old four/five-option formats trains the wrong elimination reflex for the current written exam.
The 11 Content Domains You Must Master
ABTS organizes Part I content around 11 congenital cardiac surgery topic areas, reproduced from the 2025 Booklet of Information. These are unweighted coverage categories rather than a fixed percentage breakdown, so no domain should be treated as "low yield" simply because it sounds narrow.
| Domain | Content Area |
|---|---|
| 1 | Septal Defects |
| 2 | Anomalies of Venous Connection |
| 3 | Anomalies of the Aorta, Aortic Arch, and Coronary Arteries |
| 4 | Anomalies of the Tricuspid and Mitral Valves |
| 5 | Anomalies of the Aortic Valve and Left Ventricular Outflow Tract |
| 6 | Anomalies of the Pulmonary Valve and Right Ventricular Outflow Tract |
| 7 | Conotruncal Anomalies |
| 8 | Anomalies of Atrioventricular Connection, Univentricular Heart, and Atrial/Visceral Situs |
| 9 | Diseases of the Myocardium |
| 10 | Pre-, Intra-, and Post-Operative Evaluation and Management of Congenital Cardiac Disease |
| 11 | Acquired Cardiovascular Diseases in Infants and Children |
A full breakdown of each domain, with the sub-topics examiners tend to probe, is in CHS Exam Domains 2026: Complete Guide to All 11 Content Areas. Below are three domains that deserve extra attention because they span multiple lesion families and connect to real operative decision-making.
Domain 7: Conotruncal Anomalies
Covers tetralogy of Fallot variants, truncus arteriosus, transposition physiology, and double-outlet right ventricle - lesions with overlapping anatomy and divergent repair strategies.
- Distinguish arterial switch decision points from Rastelli-type pathways
- Know how coronary patterns alter surgical approach in transposition
Domain 8: Atrioventricular Connection, Univentricular Heart, and Situs
Requires fluency in segmental anatomic analysis - situs, connections, and looping - before layering on single-ventricle palliation staging.
- Sequence Norwood, Glenn, and Fontan indications and complications
- Recognize heterotaxy-associated anomalies that change surgical planning
Domain 10: Pre-, Intra-, and Post-Operative Evaluation and Management
This domain threads through every lesion-specific question - perioperative physiology, monitoring, and complication management apply regardless of which anomaly is being tested.
- Bypass strategy and myocardial protection in neonates
- Postoperative low cardiac output and arrhythmia management
Fees, Registration, and 2026 Dates
Initial certification costs total $4,900, broken into a $650 application fee, a $1,750 written examination fee, and a $2,500 oral examination fee - before travel or preparation materials. A full line-item breakdown, including how the oral fee compares to the written fee, is available in CHS Certification Cost 2026: Complete Pricing Breakdown.
For 2026, the written examination window runs December 7-11, 2026 at Pearson Professional Testing Centers. Candidates who pass proceed to the oral examination, scheduled for June 4-5, 2027 in Dallas. That roughly six-month gap between written pass and oral sitting is intentional runway - use it, rather than cramming case prep into the final weeks. See CHS Exam Dates 2026: Testing Windows, Deadlines & Scheduling for registration deadlines tied to these windows.
Eligibility Checkpoints Before You Register
Before you can sit for Part I, ABTS requires current primary ABTS certification, unrestricted medical licensure, qualifying thoracic and congenital cardiac surgery training, verified operative experience, and formal program endorsement. Fellows who began training on or after July 1, 2023 must complete two consecutive years in a single ACGME-accredited program and log at least 150 major congenital cases, with a minimum of 50 in the first year alone.
These thresholds are strict enough that they should shape your fellowship-year planning, not just your exam-week planning. The full eligibility matrix, including how case logs are verified, is covered in CHS Requirements 2026: Eligibility, Prerequisites & How to Qualify.
Key Takeaway
Confirm your case log and program endorsement status months before the registration deadline - eligibility gaps discovered late can force you out of the 2026 written cycle entirely.
A Domain-Driven Study Timeline
Generic study techniques only help if they're mapped to CHS-specific content. The timeline below assumes roughly ten weeks of dedicated review leading into the December written window, sequencing domains by anatomic complexity rather than alphabetically.
Foundational Anatomy
- Domain 1 (Septal Defects) and Domain 2 (Venous Connection) - the building blocks referenced throughout later domains
- Build a segmental-anatomy framework you'll reuse for Domain 8
Outflow Tract Anomalies
- Domain 5 (Aortic Valve/LVOT) and Domain 6 (Pulmonary Valve/RVOT) together, since surgical decision trees overlap
Complex Connections
- Domain 3 (Aorta, Arch, Coronaries) and Domain 7 (Conotruncal Anomalies)
- Drill three-option practice questions daily to build the tighter elimination habit
Single-Ventricle and AV Pathway
- Domain 4 (Tricuspid/Mitral) and Domain 8 (AV Connection, Univentricular Heart, Situs)
- Use spaced repetition here specifically - staged palliation sequencing is easy to forget under exam pressure
Perioperative and Acquired Disease Integration
- Domain 9 (Myocardium), Domain 10 (Perioperative Management), Domain 11 (Acquired Disease)
- Full-length timed practice tests to simulate the three-option written exam
For a compressed reference during the final review stretch, keep CHS Cheat Sheet 2026: One-Page Review of Must-Know Facts on hand, and run timed sets on our practice test platform to build familiarity with the three-option question style before exam day.
Preparing for the Dallas Oral Examination
Passing Part I is only the gateway to Part II. The oral examination is case-based and administered in person in Dallas, testing whether you can talk through operative decision-making the way you would with a colleague at the table - not just recall facts. Because oral prep depends on written-exam success first, don't split attention evenly between the two until you've cleared Part I.
Use the roughly six-month gap between the December written window and the June oral date to rehearse case presentations aloud, focusing especially on domains with high decision-tree complexity: conotruncal anomalies, single-ventricle staging, and perioperative complication management. Reviewing 2025 outcome data - 4 passes among 4 oral examinees, alongside 7 passes among 8 written examinees - in CHS Pass Rate 2026: What the Data Shows can help calibrate expectations, though these cohorts are small enough that no broad conclusion should be drawn from them.
Pitfalls That Sink First-Attempt Candidates
- Treating domains as equally low-effort: Since categories are unweighted, skipping a domain because it seems narrow (like Diseases of the Myocardium) leaves real point exposure.
- Studying with outdated question formats: Four- and five-option practice questions don't train the elimination logic needed for the current three-option format.
- Underestimating registration lead time: Application fees, endorsement paperwork, and case-log verification all need to be settled well before the December window.
- Splitting focus between written and oral too early: Oral scheduling only happens after a written pass, so front-load Part I preparation first.
Once you've secured certification, remember it isn't the finish line: since January 2024, ABTS continuing certification uses non-time-limited certificates conditional on five-year milestones, including 150 Category 1 CME credits (at least 75 in thoracic surgery), qualifying case activity, an online assessment, and patient-safety requirements. That's a separate preparation cycle from the one this guide addresses, but worth planning for early. If you want a refresher on foundational terminology before or after your exam, CHS Meaning, What Does CHS Stand For?, and What Is A CHS? are quick references, and CHS Training covers the fellowship pathway feeding into eligibility.
Frequently Asked Questions
Starting in 2025, written multiple-choice questions use three answer options rather than the traditional four or five, which changes how you should approach elimination-based test strategy.
Yes. Written success on Part I is required before ABTS will schedule you for the in-person Part II oral examination in Dallas.
Initial fees total $4,900: a $650 application fee, a $1,750 written examination fee, and a $2,500 oral examination fee, not including travel or study materials.
No. They function as unweighted coverage categories drawn from the ABTS Booklet of Information, so no domain should be assumed to carry more exam emphasis than another.
You can build familiarity with three-option question style and timed conditions using our practice test platform, alongside domain-specific review resources on this site.